Large foot schwannoma with bone invasion – A case report

A rare case of a large foot schwannoma with an intraosseous component is presented. Due to suspicion of malignancy, an amputation had previously been proposed. When the patient presented to us, the prolonged clinical course as well as some elements of the imaging exams suggested benignancy and we decided for complete tumor excision. Intraoperative findings supported the benign character of the neoplasm and pathology would later confirm the diagnosis of a benign schwannoma. The outcome, at 18 months of follow-up was a fully functional limb. Recurrence must still be considered but malignant transformation is very rare in a solitary schwannoma and can be discounted.Solitary benign schwannomas have a negligible malignization potential independently of their size or osseous component. When benignancy is considered, primary total tumor excision, as part of a staged procedure, is a safe approach. It allows for a thorough pathologic examination and eventually for a definitive treatment.     

Arthroscopic management of Juxta-articular chondroblastoma with bone substitutes – A case report

Chondroblastoma, a rare benign bone tumour arising from the epiphysis, accounts for approximately 1% of all primary bone tumours and is known to be locally aggressive with potential for metastases and local recurrence. Open surgical curettage is associated with high risk of recurrence and potential for damage to the physis resulting in growth disturbances. We report a 14-year-old girl with chondroblastoma involving the distal femoral epiphysis in whom an arthroscopic approach was employed for thorough curettage of the lesion under direct vision followed by cavity management using bone graft substitute. At seven years follow-up she is asymptomatic, has normal knee function and her radiographs have shown good osteointegration of the synthetic graft with no evidence of recurrence. By combining the principles of intra-articular and endosteal arthroscopy in select patients, both tumour excision and cavity management can be done arthroscopically.     

Os intermetatarseum – A case report

Accessory ossicles and sesamoid bones are skeletal variations, more commonly seen in the region of foot and ankle. Most such accessory and sesamoid bones remain asymptomatic. However overuse and trauma can make such feet symptomatic. Knowledge of such bony ossicles is essential in the management of patients presenting with foot pain.Dorsal foot pain can be caused by a symptomatic Os intermetatarseum – an accessory ossicle found between the bases of first and second metatarsals and the medial cuneiform. Its incidence has not been well established because of insufficient appropriate multi-centric anatomical, radiological and orthopaedic studies. A case of dorsal foot pain in a soccer player, caused by an Os intermetatarseum is reported here. A brief review of the literature is also presented.     

Nephrobronchial fistula – A case report

We report the case of a 58-year-old woman with a hydronephrotic left kidney who presented with a 4-month history of anorexia, weight loss and intermittent left loin pain associated with cloudy urine. Her urine grew lactose fermenting coliforms, and was treated with antibiotics. A computerized axial tomography scan (CT scan) was equivocal and she underwent retrograde ureteric stenting, which drained a pyonephrosis. She went on to develop a chest infection due to a lung abscess. A CT scan revealed a left perinephric collection extending across the diaphragm into the lower lobe of the left lung. She responded to antibiotics and awaits a nephrectomy.     

The pathology femoral peritrochanteric fracture with multiple brown tumor as a first sign of parathyroid cancer – A case report

Introduction and importanceThe parathyroid cancer is sometime only diagnosed after a pathological fracture has occurred, and pathology fracture is often misdiagnosed as a malignancy tumor. The treatment for pathology fracture and multiple bone lesions is not defined.Case presentationWe report a 41-year-old case of parathyroid carcinoma in which pathological femoral fracture and brown tumors are the first clinical signs of the disease and that masqueraded as a malignancy tumor. The treatment for the patient was parathyroidectomy and then surgical treatment of the right femur with a locking plate osteosynthesis. Four months post-operative, the patient reported no pain and became capable of walking without a crutch. X-rays showed full bone union at fracture site of right femur, and brown tumors regression seen to be taking place in the upper limb, lower limbs and pelvis.Clinical discussionA brown tumor was diagnosed by a high concentration of blood parathyroid hormone and serum calcium. Despite the lack of clinical guidelines, most authors agreed that parathyroidectomy was the first choice of treatment then orthopaedic treatment. The principles of osteosynthesis of fracture were based on stable osteosynthesis. It was reported that osteolytic lesions caused by brown tumor were recovered when hyperparathyroidism had been treated.ConclusionBrown tumor needs to be considered in the differential diagnosis when there are osteolytic lesions and high serum calcium. It is advisable to have a parathyroidectomy and then orthopaedic treatment. Brown tumor with Mirels' score less than 7 scores should be applied a conservative treatment.     

Symptomatic pneumopericardium – A rare complication following retroperitoneal laparoscopic nephrectomy: A case report

Introduction and importancePneumopericardium is collection of gas in pericardial space. Retrospective reviews have described pneumopericardium as a complication of laparoscopic surgery, however, without any symptoms. By this report, we present a case who developed acute cardiopulmonary symptoms after retroperitoneal laparoscopic radical nephrectomy because of pneumopericardium.Case presentationA 40-year-old Vietnamese woman was admitted due to left flank pain. She was diagnosed with left dysfunctional hydronephrosis and right urolithiasis. Six hours post-operation of an elective retroperitoneal laparoscopic radical nephrectomy, she suddenly developed severe substernal chest pain and dyspnea. Evaluations for acute myocardial infarction and pulmonary embolism were immediately ordered with no abnormality. However, computed tomography scan of the chest showed pneumopericardium, pneumomediastinum, subcutaneous emphysema, gas collection in sub-peritoneal space and next to the aortic arch. She was then closely monitored and effectively managed by conservative treatments.Clinical discussionPneumopericardium is a rare complication of laparoscopy and mainly detected by radiographical measures incidentally. Several case studies reported symptomatic pneumopericardium, as in our presenting case. Some factors might contribute to the mechanism of our case that include retroperitoneal approach, thoroughly dissection the renal helium area and long-lasting operation. Post-operative collection of carbon dioxide is well self-limited; therefore, conservative treatments are efficient for stable cases.ConclusionPneumopericardium following laparoscopy is uncommon, and mostly subclinical. However, it can manifest as acute cardiopulmonary symptoms and signs that require carefully evaluation. The presence of gas in pericardial space is a negative prognosis factor itself; consequently, clinicians should be aware of when managing pneumopericardium subsequent to laparoscopic procedures.     

The transfer of the posterior femoral condyle – first results of a salvage operation

In this study large osteochondral defects on the weight-bearing surface of the medial and lateral femoral condyle were treated by transplantation of the autologous posterior condyle in 20 patients. The cartilage defects, type Outerbridge IV, ranged in size from 2 x 1.5 cm to 5 x 3.5 cm. 8 condyle transfers were done from 1984-1996 at the orthopaedic clinic of the university of Balgrist, Zürich. 12 condyle transfers at the department of orthopedic sports medicine at the technical university of Munich from 1996-1998. Patients were operated before the condyle transfer, 2 times on average. In 9 patients a high tibial osteotomy was performed simultaneously. Clinical evaluation was done according to the Lysholm score. The Lysholm score improved in the patient serie from 1996 from preoperatively 62 (54-81) points to postoperatively 85 (74-95) points. The follow-up was on average 9.8 (2-26) months. 18 patients reported about pain relief, 2 patients didn't improve. We describe the operative technique. Despite the lack of long-term results the transfer of the autologous posterior condyle seems to be an effective alternative for the knee prosthesis, especially for young patients with a great cartilage damage in the weight bearing area.     

Medial tibial stress syndrome: A skeleton from medieval Rhodes demonstrates the appearance of the bone surface – a case report

The effect of immobilization on bone formation in the knee and hip was studied by means of oxytetracycline. One leg of 11 growing and 13 adult rabbits was immobilized so that the knee was held in extension but the hip was free. In the knee, degenerative changes developed consistently with a severity proportional to the length of the immobilization time. In most of the rabbits given oxytetracycline 1–13 days before they were killed considerably more oxytetracycline was incorporated in the bone in the immobilized knee region and slightly more in the hip region of the same leg than in the corresponding areas of the other leg. This indicates an increased turnover of bone tissue in the immobilized leg compared with the non-immobilized leg.     

Hepatic hemangioendothelioma – A rare case report

Introduction and importanceHepatic hemangioendothelioma (HHE) is a very rare mild-moderate malignant tumor of the hepatic vascular endothelium. The etiology is yet not fully understood. Patients can be asymptomatic or may present with non-specific symptoms or hepatic insufficiency. CT and MRI scans show various radiographic features but a definitive diagnosis can be made with histological analysis and immunohistochemistry. Here we report a case of a patient who presented with a non-resectable disease for which living donor liver transplantation was done.Case presentationA 19-year-old female patient presented with intermittent moderate dull pain in the right hypochondrium for 9 months. Examination revealed mild tender hepatomegaly. On abdominal ultrasound, two hypoechoic lesions were noted in both lobes of the liver that were confirmed on CT scan. Histologic examination of the ultrasound-guided fine-needle aspiration cytology of the voluminous right lobe lesion clinched the diagnosis of HHE. The patient underwent successful living donor liver transplantation due to the multifocal bi-lobar nature of the lesions. At 8 months follow up, she is fine and doing well.ConclusionHHE is a very rare mild-moderate malignant tumor of hepatic vascular origin. Resection is the preferable treatment option in patients with resectable disease. However, liver transplantation has become the treatment of choice for patients with non-resectable multifocal and bi-lobar lesions. The long-term outcome of this malignancy is not fully known and there is a need for long-term follow-up studies to determine the actual recurrence rate of this disease.     

Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature

Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication.     

Quadruple primary urogenital cancers – A case report

IntroductionUrogenital cancers are not an uncommon occurrence in daily practice. Prostate cancer is the second most frequent cancer in men, kidney cancer accounts for 2.4% of all cancers and bladder cancers represent 3.1% of cancers in both men and women [1]. However, the cases of a simultaneous development of all three cancers, including one with a neuroendocrine component, are very few and far between.Presentation of caseOur case report involves a case of a patient with prostate adenocarcinoma, clear-cell renal carcinoma, papillary renal carcinoma and small-cell bladder cancer. The patient was treated as if he had separate pathologies by a multidisciplinary team: surgical and oncological, performing radical cystoprostatectomy with left perifascial nephroureterectomy, right ureterostomy and adjuvant chemotherapy, with excellent outcome even four years after the initial diagnosis.DiscussionThe distinct features of this case are the occurence of four different malignancies of the urogenital system, the family history of colon cancer, the development of small-cell carcinoma of the bladder, which is extremely rare and the good outcome, despite the quadruple malignancies and the aggresivity of the small-cell carcinoma.ConclusionMutiple primary malignancies are a relatively rare pathology, but should be considered as a possibility in patients who already had a second malignancy. Cases of patients with MPMs should be supervised by a multidisciplinary team and should be followed closely.     

"Migration" of traumatic subarachnoid hematoma? A case report

BACKGROUND: Traumatic spinal SAH with neurologic deficits is rare and easily misdiagnosed, especially after traumatic intracranial hemorrhage. CASE DESCRIPTION: We report a case of spinal SAH with root compression occurring after a scooter accident. CONCLUSIONS: Physicians should be aware of descending migration of intracranial SAH as a possible cause of spinal cord or root compression, especially in the patient with late onset spinal symptoms.     

Osteonecrosis of the lateral femoral condyle following anterior cruciate ligament reconstruction: is bone bruising a risk factor?

Osteonecrosis of the knee is extremely rare following anterior cruciate ligament (ACL) reconstruction surgery. We report a case of osteonecrosis of the lateral femoral condyle in a patient after ACL reconstruction. The osteonecrotic lesion occurred in the same area as a large bone bruise, which was sustained at the time of the initial injury. We hypothesize that the combination of bone bruising and femoral tunnel drilling for ACL reconstruction may have compromised the overall vascularity of the articular cartilage and the subchondral bone, thereby resulting in osteonecrosis.